Background: Infected non-union of long bones is a problem in the developing countries. Persistent infection, deformity, shortening, bone loss, joint stiffness and disability complicate the non-union. Secondary procedures are often required for correction of bone defects and deformity. Ilizarov method addresses all the above problems simultaneously and offers a panacea for infected non-unions. The stability of the fixation and provision for bone transport allows bridging of bone defects, limb lengthening, early weight bearing ambulation and joint mobilisation.
Data from 565 knee arthroscopies performed by two experienced knee surgeons between 2002 and 2005 for degenerative joint disorders, ligament injuries, loose body removals, lateral release of the patellar retinaculum, plica division, and adhesiolysis was prospectively collected. A subset of 109 patients from the above group who sequentially had clinical examination, MRI and arthroscopy for suspected meniscal and ligament injuries were considered for the present study and the data was reviewed. Patients with previous menisectomies, knee ligament repairs or reconstructions and knee arthroscopies were excluded from the study. Patients were categorised into three groups on objective clinical assessment: Those who were positive for either meniscal or cruciate ligament injury [group 1]; both meniscal and cruciate ligament injury [group 2] and those with highly suggestive symptoms and with negative clinical signs [group 3]. MRI was requested for confirmation of diagnosis and for additional information in all these patients. Two experienced radiologists reported MRI films. Clinical and MRI findings were compared with Arthroscopy as the gold standard. A thorough clinical examination performed by a skilled examiner more accurately correlated at Arthroscopy. MRI added no information in group 1 patients, valuable information in group 2 and was equivocal in group 3 patients. A negative MRI did not prevent an arthroscopy. In this study, specificity, positive and negative predictive values were more favourable for clinical examination though MRI was more sensitive for meniscal injuries. The use of MRI as a supplemental tool in the management of meniscal and ligament injuries should be highly individualised by an experienced surgeon.
BackgroundAlthough previously reported, ipsilateral Monteggia fracture dislocation and distal radius fracture in a child is still a rare occurrence. A full clinical examination may be difficult but should not be ignored. Full length forearm radiographs are ideal but proper limb positioning may be difficult. The injury pattern can be easily missed.Case presentationA five-year- old right hand dominant Caucasian male presented with a history of fall on outstretched hand. Clinical examination was difficult and X - rays confirmed type III Monteggia fracture with an ipsilateral Type II Salter Harris injury of the distal radius and ulna.ConclusionThis report highlights the need for relevant examination of the wrist and elbow in young children. Appropriate radiographs must also be performed to prevent missing these injuries.
A 25-year-old healthy male solicitor was involved in a road traffic accident, being knocked off his motorbike by a car. He presented with an abrasion over the medial aspect of the right ankle and swelling of his right foot. The ankle was diffusely tender on the medial aspect and passive ankle movements were restricted and painful. There was no distal neurological deficit and posterior tibial and dorsalis pedis pulsations were palpable. Survey for associated skeletal injuries was negative.X-ray of the right ankle revealed a fracture of the medial malleolus with wide displacement of the fragments. The fibula and syndesmosis were intact ( Fig. 1).Urgent surgery was carried out for the medial malleolar fracture. The fracture was exposed through a medial longitudinal incision and the fragments were found to be widely displaced. The tibialis posterior tendon was found to be lacerated about 2 cm proximal to the fracture site and the distal stump was found interposed in the fracture site. The tendon appeared healthy otherwise. The incision was placed anterior in order to avoid the abrasion and had to be extended to retrieve the proximal end of the severed tendon. The frayed tendon edges were freshened and repaired after fixation of the medial malleolar fracture with two partially threaded cancellous screws. The screws were positioned a little anterior in order to protect the repair. The deltoid ligament was found to be intact and there was no osteochondral injury noted in the ankle joint on exploration. The ankle and foot were immobilised in a resting plaster for four weeks postoperatively, followed by progressive weight bearing as tolerated.Radiological union of the fracture had occurred by 14 weeks and return to full activities of daily living was possible by 6 months. At the time of last review 30 months following surgery, the foot arches were well maintained and he had achieved a full range of active ankle and foot movements, although the terminal 108 of inversion and eversion were associated with some discomfort (Fig. 2). DiscussionThe tibialis posterior tendon lies close to the medial malleolus and beneath the flexor retinaculum, which binds the tendon to the bone. This location of the tendon precludes it from direct laceration. 8 The anatomic arrangement at the ankle prevents
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